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‘I’ll just walk': Dr. Glaucomflecken discusses ambulance billing in viral video

The ophthalmologist and comedian shares how the No Surprises Act impacts out-of-network billing


By Bill Carey

PORTLAND, Ore. — Oregon ophthalmologist and comedian Will Flanary, aka Dr. Glaucomflecken, shared a YouTube video on the surprising costs of healthcare billing in his latest series about the “No Surprises Act.”

In the video, Flanary explains how a hospital might be in your network, but some of the healthcare providers who work within that hospital may be out of network.

The result is that a patient being billed out-of-network can be charged any amount the healthcare provider wants. Flanary explains it in more detail in his blog post:

“Imagine this scenario. You have a cardiac arrest in your sleep at home. Paramedics rush in, get your heart beating, and load you into an ambulance. You end up in the ICU of your local hospital. When you get home, you start receiving bills. Some bills are extreme, and you try to figure out why they are so high and why your insurance isn’t covering any portion. You learn that while you were unconscious, you were lucky enough to end up at an in-network hospital, but some of the healthcare providers that helped to save your life were out-of-network.”

Many viewers, including some in EMS, commented on Flanary’s YouTube video, commiserating about the surprise billing,

“I’m an EMT in Utah. I will probably discuss how much transport could cost every other day. The problem with this is that the crew in the truck has no idea how billing works or how much anything is set to cost. We are only told that there is a set fee to transport, and then we charge by the mile plus supplies used. Explaining that to a sick person or their family can be frustrating and confusing.”

“As an American paramedic, this didn’t make me angry as much as sad. The amount of times I’ve had to tell patients they need to go and not to worry about the bill is depressing. At my last job – a private company – we had a phone number we could call for someone in the billing office, who would assure them their bill wouldn’t be sent to collections and they’d work out a payment plan. At my current job, a city-owned service, I have to tell people that billing is above my pay grade. It really hurts that I work for a public tax-supported entity and people still worry about how much their city is going to bill them for ambulance service.”

“I’m a career paramedic and unfortunately have to have these conversations a lot. One thing I think people don’t understand is that outside of major cities, the vast majority of ambulance services are not municipally run. Most of these companies are either nonprofit ambulance companies or volunteer fire companies. This means without meaningful municipal funding they are almost completely dependent on billing to support their services. Unlike large hospital systems, these small diffuse companies have no bargaining power with insurance companies driving reimbursement rates down. Ambulance services are almost always out of network bc in-network reimbursement rates are too low to keep the lights on. It’s a bad situation for patients and providers and is killing EMS, particularly in our rural areas.”

“I’m a doctor and when I went to urgent care and was diagnosed with pneumonia and low oxygen they wanted to send me to the ER in an ambulance. I signed out against medical advice and drove myself. (Also because I knew the nearest hospital was out of network and I didn’t want to deal with that).”